An early start for childhood obesity

A SILENT EPIDEMIC is spreading through the land, touching every county and townland and overtaking almost a third of all of our children. Yet many parents either don’t realise or don’t worry that their children face this threat.

Obesity has risen sharply over the past few years with more and more children effected. And diabetes incidence often follows close behind as the children mature into young adults. For this reason the National Children’s Research Centre at Crumlin, Dublin, has made these two conditions a priority for research, says the centre’s director, Prof Carlos Blanco.

The centre has set up a collaboration with the Human Development and Health research unit at the University of Southampton to study the very earliest causes of obesity, he says.

The emphasis of most medical intervention occurs after a person has become obese, and usually later in life, he says.

Yet the drivers for obesity actually arise much earlier, in what health workers in the US describe as the first critical 1,000 days. This encompasses the nine months of pregnancy and the first two years of life. “We want to work in that area,” Blanco says.

Since its foundation in 1965 the centre has been at the heart of paediatric medicine here, Prof Blanco says. Also a consultant neonatologist at Holles Street, he was appointed director of research in 2009.

The centre went through a restructuring in that year and it now helps drive paediatric research here in collaboration with all the paediatric hospitals and with Trinity College Dublin, University College Dublin, University College Cork and the Royal College of Surgeons in Ireland.

The centre itself was also refurbished and it now supports the work of about 70 clinical and academic researchers. “The centre funds research, clinical and basic research and translational research. It starts sometimes from molecular biology but we also do clinical trials. The focus is always on paediatrics,” Blanco says.

It issues open calls for research proposals twice a year, with the winning awards decided by international peer review. “The number of projects supported depends on how much money we have when issuing grants.”

The necessary funding is channelled to the centre via the Children’s Medical and Research Foundation. The foundation is the engine that keeps the centre going, funding research and enabling scientists and clinicians to make the medical breakthroughs.

“The foundation created this, providing the money to support the research,” Blanco says.

The Foundation will invest €6.7 million in research this year and given the five year duration of many projects, the centre is committed to expenditure of about €30 million through 2014.

The money comes from the public via flag days, bequests and other sources. “They [the public] are very good. Of course the situation has changed over the last few years but we had reserves,” he says, a reference to the ongoing economic downturn.

The centre focuses on a restricted range of areas with the genetics of cancer a particularly important area. Here researchers seek to find the genetic causes of the disease as a way to develop new treatments.

Immunology and inflammation represent another important area for the centre because inflammation is now being linked to a host of common but life threatening disorders including cancer.

Obesity and diabetes are on the priority list as are autism, congenital malformations and gastro-intestinal disease, he adds.

The centre also supports clinical trials including drug trials and it has all the necessary infrastructure to support these. Three trials are currently underway in the clinical research unit at the centre, he says.

Teaching remains an important area of support, seen in its MSc research programme, which at the moment involves 20 students.

“We want to teach people how to conduct research and to produce the researchers of the future,” Blanco says.

The centre’s support for clinical research into cystic fibrosis provides a good example of how it can help build a critical mass of advanced study into a disease through the judicious use of funding. It is supporting seven projects aimed at improving the quality of life and life expectancy of children with the disease. A number of the projects include research linkages with centres abroad including the University of California, San Francisco, and the University of North Carolina, Chapel Hill.

The Irish/USCSF study is looking at bacteria in the lungs of CF patients and how the microbes trigger inflammation in these tissues. The other is a multi-centre study looking at anaerobic bacteria and how they affect lung function.

Returning to the issue of obesity, studies are under way to see if educational programmes for younger people might succeed where efforts among the older population have failed, Blanco says. “We want to see if we can change attitudes.”

A study in Cork involves monitoring 2,700 children over their first five years of life. “By the end of the study about 38 per cent of them are going to be overweight already,” Blanco says.

Other studies are targeting the 10 to 13 age group and also older teenagers. “We have a cohort of teenagers and we will attempt to enhance education about weight and obesity through the internet.”

New media is an important tool when working with younger age categories, he says. For this reason material is provided via the internet and Twitter. An app has been developed that acts like the person’s “superego” who can be asked whether certain foods can be eaten at certain times without exceeding recommended calorie intake.

Why the blame game is ‘massively unhelpful’

Overeating and lack of exercise are not always the root cause of obesity in children. Research increasingly shows that the problem begins much earlier, back to the child’s environment while still in the womb.

“We are looking at the very earliest causes of obesity. We believe the problem begins in the womb before birth,” says Prof Carlos Blanco, director of the National Children’s Research Centre at Crumlin hospital.

Childhood obesity and diabetes are key research areas for the centre, an interest sparked by the rapid rise of these conditions in children here, he says.

Rather than start developing a research programme from scratch, the centre decided to link up with Prof Mark Hanson of the University of Southampton.

The British Heart Foundation professor of cardiovascular disease is also the director of the university’s research centre for Human Development and Health .

It has studied the “early life origins of non-communicable diseases” for 20 years and currently involves the work of 300 researchers, Hanson says. “The early life environment has an impact on the offspring and its risk of conditions like diabetes.”

Researchers in his centre look for genetic markers that can predict an infant’s level of risk in later life of becoming obese or developing cardiovascular disease.

Only last April his group published a research paper in the journal Diabetes showing that children with a specific genetic marker present before birth had a 25 per cent increased risk of being obese by the age of nine.

The research indicates that the mother’s health status during pregnancy could influence the genetic change in the child. This means the mother’s health status could have a direct impact on the health risks faced in later life by the child.

Hanson stressed however that the research was not about apportioning blame.

“We have to get away from any notion of blame or responsibility,” he says. “It is massively unhelpful. This is part of normal human development.”

It is becoming increasingly clear that subtle changes in the environment within the womb can cause genetic changes in the newborn, leaving them predisposed to these conditions, he says.

He is helping the Crumlin centre develop a similar research programme of its own.

“We are collaborating on a new programme to address the problem in Dublin that is specific to the Irish situation,” he says, adding it represented a ”fantastic opportunity” for both centres.

For more information about the important life-saving work supported by the Children’s Medical Research Foundation see its web site, cmrf.org